SEASONAL PATTERN ASSESSMENT QUESTIONNAIRE (SPAQ)

Date of Birth: (dd/mm/yyyy) / // / Sex: / Male / Female
Date form completed: (dd/mm/yyyy) / //

The purpose of this form is to find out how your mood and behaviour change over time

  1. At what time during the year do you…? (please select each month that applies. This may be a single month, or a cluster of months)

JAN / feb / mar / apr / may / junE / julY / aug / sept / oct / nov / dec
A. Feel best
B. Gain most weight
C. Socialise most
D. Sleep least
E. Eat most
F. Lose most weight
G. Socialise least
H. Feel worst
I. Eat least
J. Sleep most
0
no change / 1
slight change / 2
moderate
change / 3 marked change / 4 extremely marked change
A. Sleep length
B. Social activity
C. Mood (feeling of well being)
D. Weight
E. Appetite
F. Energy level
  1. To what degree do the following change with the seasons? (Mark one square only per question)
  1. If you experience changes with the seasons, do you feel that these are a problem for you?

No Yes

Mild / Moderate / Marked / Severe / Disabling

If yes, is the problem…

  1. By how much does your weight fluctuate during the course of the year?

(Please tick one box only)

0-3 lbs / 12-15 lbs
4-7 lbs / 16-20 lbs
8-11 lbs / Over 20 lbs
  1. Approximately how many hours of each 24-hour day do you sleep during each period of the year? (including naps) (please markone number for each season)

1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12 / 13 / 14 / 15 / 16 / 17 / 18 / 18+
WINTER
(Dec 21 – Mar 20)
SPRING
(Mar 21 – June 20)
SUMMER
(June 21 – Sept 20)
AUTUMN
(Sept 21 – Dec 20)
  1. Do you notice a change in food preference during the different seasons?

No Yes

  1. If you suffer from any other changes in your wellbeing across the seasons of the year, please describe it in the space below

Thank you for completing the questionnaire.

A selection of people who submit responses will be contacted about taking part in the study.

Do you give your permission to be contacted by the study’s Research Assistant about participation in this study? Yes No

In order to submit your responses on this questionnaire to be considered for the research, you will now need to send your questionnaire to the study’s Research Assistant by one of the following methods:

  1. By e-mail:
  2. Save this completed form to any location on your computer (click: File/Save As). Give your questionnaire any file name you wish.
  3. Send a blank e-mail with the questionnaire as a file attachment to the study’s Research Assistant:
  1. By Post:
  2. Save this completed form to any location on your computer (click: File/Save As). Give your questionnaire any file name you wish.
  3. Print the completed questionnaire and send it by postaddressing theenvelope to: Matthew Charles

Neurosciences

University Department of Psychiatry

WarnefordHospital

Oxford

OX3 7JX

If you have any questions about completing this form, how to submit your responses, or about the study in general, please do not hesitate to contact the study’s Research Assistant, Matthew Charles, by the e-mail or postal addresses above, or by telephone on 01865 223612.

Thank you for your time.